Crohn's disease: antibiotics show modest benefit in Cochrane review

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Takeaway

  • A Cochrane review finds that the benefits of antibiotics for induction or maintenance of remission of Crohn's disease (CD) are modest and may not be clinically meaningful.
  • Antibiotics are not harmful, although the risk for serious adverse events remains uncertain.

Why this matters

  • Firm conclusions cannot be drawn about the efficacy and safety of antibiotics on the induction and maintenance of remission.

Study design

  • Review and pooled analysis of 13 randomized controlled trials after a review of MEDLINE, EMBASE, CENTRAL, the Cochrane IBD Group Specialized Register, and clinicaltrials.gov.
  • Funding: None disclosed.

Key results

  • In pooled analysis, 14% fewer antibiotic than placebo recipients failed to enter clinical remission at 6-10 weeks (risk ratio [RR], 0.86; 95% CI, 0.76-0.98).
  • No fewer antibiotic than placebo recipients failed to maintain clinical remission at 52 weeks' follow-up (RR, 0.87; 95% CI, 0.52-1.47).
  • 23% fewer antibiotic than placebo recipients failed to achieve clinical response at 10-14 weeks (RR, 0.77; 95% CI, 0.64-0.93).
  • Antibiotic recipients (vs placebo) had no greater likelihood of adverse events as a whole, but likelihood of serious adverse events was uncertain.

Limitations

  • Heterogeneity across studies.
  • Evidence quality ranges from high to low, depending on the outcome.